MA-ACA Update

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AFFORDABLE CARE ACT

MASSACHUSETTS IMPLEMENTATION UPDATE

August 5, 2013

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These Updates, published by the Executive Office of Health and Human Services (EOHHS) in consultation with the other state agencies involved in ACA implementation, will bring you news related to the implementation of provisions of the ACA here in Massachusetts.

Grants and Demonstrations

The ACA provides funding opportunities to transform how health care is delivered, expand access to care and support healthcare workforce training.

Grant Announcements

Veterans to Nurses and Physician Assistants Workforce Program, §5301, 5309. Announced July 25, 2013. Funding is available to provide education to veterans with prior medical training to become civilian nurses and physician assistants. Accredited public or nonprofit private hospitals, schools of medicine or osteopathic medicine, or academically affiliated physician assistant training programs are eligible to apply. In addition, a school of nursing, a health care facility, or a partnership of such a school and facility are also eligible to apply. Applicants must address providing education to veterans to become nurses/nurse practitioners and physician assistants. The grantee will be involved in activities such as: preparing civilian faculty and administrators to respond to the unique academic needs of veterans, developing assessments of career programs for veterans and disseminating best practice models.

Applications are due August 26, 2013.

The announcement can be viewed at: HRSA

Grant Activity

For information about ACA grants awarded to and grant proposals submitted by the Commonwealth, visit the Grants page of the Massachusetts National Health Care Reform website at: http://www.mass.gov/eohhs/gov/commissions-and-initiatives/healthcare-reform/national-health-care-reform-plan/grants-and-demonstrations.html

Guidance

7/29/13 HHS/CMS filed an ACA-related notice called "Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System -Update for Fiscal Year Beginning October 1, 2013 (FY 2014)." The notice updates the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs).

According to the notice, payments for FY2014 for inpatient psychiatric care would be increased by 2.3%. The update applies to 481 freestanding IPFs and 1,143 hospital-based inpatient units. The changes are applicable to IPF discharges occurring during the fiscal year (FY) beginning October 1, 2013 through September 30, 2014. The updates implement portions of ACA §3401.

Read the notice (which was published in the Federal Register on August 1, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-08-01/pdf/2013-18445.pdf

Prior guidance can be found at: http://www.hhs.gov/healthcare/index.html

News

7/30/13 The U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation statement on screening for lung cancer. The USPSTF recommends annual screening for lung cancer in people who are at high risk for lung cancer with annual low-dose computed tomography (LDCT), also known as CT scans. The USPSTF assigned a "B" rating to the recommendation, indicating that the Task Force recommends the service.

According to the USPSTF, smoking is the biggest risk factor for developing lung cancer, resulting in about 85% of lung cancers in the United States. The risk for developing lung cancer also increases with age, with most lung cancers occurring in people age 55 or older.

After reviewing the evidence, the USPSTF recommends screening people who are 55 to 80 years old and have a 30-pack-year or greater history of smoking, who are either current smokers or have quit in the past fifteen years. A "pack year" for a person is calculated as someone who has smoked an average of one pack of cigarettes per day for a year. For example, a person attains 30 pack years of smoking history by either smoking a pack a day for 30 years or two packs a day for 15 years. The USPSTF recommends the screening because the evidence suggests that it may prevent a significant number of lung cancer-related deaths.

The USPSTF is an independent panel of non-federal government experts that conduct reviews of scientific evidence of preventive health care services. The USPSTF then develops and publishes recommendations for primary care clinicians and health systems in the form of recommendation statements. As part of their recommendations process, the USPSTF will assign definitions to the services they review based on the certainty that a patient will receive a substantial benefit from receiving the benefit. Services that are graded "A" and "B" are highly recommended and the USPSTF believes there is a high certainty that patient will receive a substantial or moderate benefit.

Under ACA §1001, all of the recommended services receiving grades of "A" or "B" must be provided without cost-sharing when delivered by an in-network health insurance provider in the plan years (or, in the individual market, policy years) that begin on or after September 23, 2010. If the recommendation is finalized with the "B" rating then the screenings will be required to be covered without cost-sharing under the ACA.

Comments on the draft are due August 26, 2013 and can be submitted at:

http://www.uspreventiveservicestaskforcecomments.org/?dno=bGVfODc3NXpteGclM2Q$

Read the draft recommendation statement at: http://www.uspreventiveservicestaskforce.org/draftrec.htm

Learn more about preventive services covered under the ACA at: HHS.Gov

Learn more about the USPSTF at: http://www.uspreventiveservicestaskforce.org/

Commonwealth of MA News

On July 30, 2013, the Health Connector launched a new microsite or mini-website, for Massachusetts residents who are interested in learning more about the changes that will be happening under the ACA. The new mini-website, linked from the Health Connector's current website, includes information for Massachusetts individuals and small businesses about upcomong ACA changes and introduces visitors to the site to the Health Connector's new marketplace that will officially launch on October 1, 2013.

There are also a number of links on the site with information such as FAQs for individuals and employers in Massachusetts, a glossary of important "ACA terms" and upcoming forums and presentations where Health Connector staff will be present to answer questions about ACA implementation. The site is currently highlighting this year's summer health insurance open enrollment period. The information on the site will be frequently updated to reflect any changes and key milestones.

Visitors to the new microsite will also have the ability sign up for email notifications at: http://bettermahealthconnector.org/updates/sign-up-for-updates/

On July 18, 2013, Massachusetts submitted comments to HHS/CMS on the proposed rule called "Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards." The goal of the proposed rule is to ensure access to affordable health insurance for consumers and to safeguard federal funds through program integrity activities.

The proposed rule describes standards for agents, brokers and health insurance issuers who provide services and supports in Federally-facilitated Exchanges. The proposed rule also requires that states collect information on their reinsurance and risk adjustment programs, provide this information to HHS and submit reports to the public on these programs. In addition, HHS proposes standards for the oversight of premium tax credits and cost-sharing reductions that include the maintenance of records and annual reporting to HHS. HHS also provides flexibility by allowing states to run a state-based Small Business Health Options Program (SHOP) while the federal government manages the individual market in the Federally-facilitated Exchange. The rule also establishes criteria for enrollee satisfaction survey vendors, standards for handling consumer complaints, consumer protections, and other activities to ensure smooth operation of the Health Insurance Exchange.

The ACA established Affordable Health Insurance Exchanges (§1311(b)) to provide individuals and small business employees with access to health insurance coverage beginning January 1, 2014, where low and moderate income Americans will be eligible for premium tax credits (§1401, §1411) to make purchasing a health plan more affordable by reducing out-of-pocket premium costs. §1311(b)(1)(B) requires that SHOP assist qualified small employers in facilitating the enrollment of their employees in qualified health programs (QHPs) offered in the small group market. QHPs are health plans that have been certified by an Exchange, provide essential health benefits (§1301) and follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts).

The ACA also directs the HHS Secretary to develop and administer a quality rating system and an enrollee satisfaction survey system, the results of which will be available to Exchange consumers shopping for insurance plans. In addition, the ACA established risk-mitigation programs to stabilize premiums in the individual insurance market and minimize the effects of adverse selection that may occur as insurance reforms and the Exchanges launch in 2014. These programs include reinsurance (§1341) and risk adjustment programs (§1343) to provide payments to health insurance issuers that cover higher-risk populations and to more evenly spread the financial risk borne by issuers.

The comment period has closed but a link to the June 19, 2013 Federal Register notice containing the proposed rule can be read at: http://www.gpo.gov/fdsys/pkg/FR-2013-06-19/pdf/2013-14540.pdf

The Massachusetts comment letter can be read online at the Massachusetts national health reform website under the State and Federal Communications section at: http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/state-fed-comm/130718-comments-on-program-integrity.pdf

Upcoming Events

Massachusetts Health Homes Initiative Public Forum

August 22, 2013

1:30 PM - 3:30 PM

Worcester Public Library, Saxe Room

3 Salem Street

Worcester, MA

Integrating Medicare and Medicaid for Dual Eligible Individuals Implementation Council Meeting

August 15, 2013

1:00 PM - 3:00 PM

1 Ashburton Place, 21st Floor, Conference Rooms 1, 2 & 3

Boston, MA

MBTA and driving directions to 1 Ashburton Place are located here: http://www.mass.gov/anf/employment-equal-access-disability/employee-prog-and-training/training-and-learning-dev/directions/boston-training-sites/one-ashburton-place.html

The Implementation Council welcomes attendance at its meetings from all stakeholders and members of the public with interest in the Demonstration. Reasonable accommodations will be made for participants who need assistance. Please send your request for accommodations to Donna Kymalainen at Donna.Kymalainen@state.ma.us.

Quarterly Affordable Care Act Implementation Stakeholder Meeting

September 16, 2013

1:30 PM - 2:30 PM

1 Ashburton Place, 21st Floor

Boston, MA

Bookmark the Massachusetts National Health Care Reform website at:

National Health Care Reform to read updates on ACA implementation in Massachusetts.

Remember to check the Mass.Gov website at: Dual Eligibles for information on the "Integrating Medicare and Medicaid for Dual Eligible Individuals" initiative.